Initiate Government Solutions supports VA Financial Services Center (FSC) Healthcare Claims Adjudication

January 9, 2018

 

As part of the CNSi award for VA FSC Healthcare Claims Adjudication, IGS will provide support to integrate the solution into the existing FSC environment.

 

The FSC is authorized by the Government Management Reform Act of 1994 (Public Law 103-356) to provide common administrative support services on a reimbursable basis to VA and Other Government Agencies (OGA’s), as a Franchise Fund.  The goals of the Franchise Fund organizations include:

 

  • Lowering overhead costs

  • Improving the quality and delivery of services

  • Creating economies of scale

  • Eliminating redundant services

  • Being audit-able

 

VA-FSC requires a system that can be used to adjudicate, process, and prepare for payment of healthcare claims submitted by healthcare providers. Increased healthcare demands require the VA-FSC to modernize its legacy healthcare claims adjudication system to be more efficient. This includes migrating both existing and potential customers into the system. The current FSC system is a COTS legacy claims adjudication system. This system adjudicates, processes, and pays healthcare claims for four programs supporting the healthcare processing product line. These include: VA Choice, Dialysis National Contract (DNC), the Camp Lejeune Family Member Program (CLFMP) and Other Government Agencies (OGA).

 

With the current system, each of the four programs uses a legacy system in a separate environment with multiple interfaces all of which are external to the legacy system. FSC currently maintains and operates separate environments for each of these programs to address the technical limitations of this legacy client/server technology. The current system is decentralized, requiring cross-coordination efforts across several parties and highly manual manipulation requiring a lot of staff support. With the implementation of the new centralized, configurable, and modularized system, we expect to see efficiencies realized across several areas.

 

CNSi and IGS is working with VA-FSC to procure and integrate a COTS software that is designed to handle the enterprise adjudication solution to adjudicate medical claims submitted by healthcare providers. This new solution will address issues to increase effective and success with the Improper Payments Elimination and Recovery Act. This new solution will also reduce high program costs, reduce time taken to process claims, and create a centralized, automated, future state. This new solution will also provide flexibility to accommodate future growth as well as possibility of processing medical claims that do not fall under the VA Community Care Network contract.

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